MalariaCare works across all 11 of Zambia’s provinces to improve diagnosis and treatment of malaria and other illnesses. In collaboration with partners, the project strengthens diagnostic testing by establishing strong quality measures and building the skills of health workers. MalariaCare also aims to improve the capacity of clinicians and community health workers (CHWs) to provide appropriate treatment for malaria and other febrile illnesses.
Context for MalariaCare in Zambia
Malaria continues to be a major cause of morbidity and mortality in Zambia, and control of the disease is one of the government’s highest priorities. The National Health Management Information System in 2011 reported more than 4 million clinical and laboratory-confirmed malaria cases and more than 4,500 malaria deaths. Although the number of malaria cases decreased from 2000 to 2008, an increase was reported in 2010 in several provinces.
In 2010, the country adopted World Health Organization (WHO) guidance calling for universal diagnostic testing for malaria and recommending that antimalarial treatment be administered only when a test is positive. Previously, most health providers in Zambia diagnosed malaria clinically based on the presence of fever.
In response to the policy shift, the National Malaria Control Centre (NMCC) has taken significant steps toward strengthening the quality of malaria diagnostics and improving access to malaria testing. Notably, from 2009 to 2012, the Improving Malaria Diagnostics project helped introduce onsite training and supportive supervision to promote diagnostic testing for suspected malaria cases and improve quality assurance of test results.
The NMCC’s recent National Malaria Strategic Plan aims to achieve universal diagnosis and appropriate treatment for all suspected malaria cases by 2015.
Building diagnostic capacity. MalariaCare is helping to strengthen diagnostic capacity by conducting a national-level microscopist accreditation course for expert laboratory technicians. The project is also updating and distributing national laboratory training manuals to laboratory staff at health facilities.
Developing a national framework for high-quality diagnostics. To help the government achieve its goal of universal testing of suspected malaria cases by 2015, MalariaCare is working with the NMCC and the national malaria case management technical working group to develop a comprehensive quality assurance and quality control framework for malaria diagnostic testing at all levels of the health care system.
Enhancing pre-service training for laboratory workers and clinicians. In collaboration with a wide range of partners, MalariaCare is working to improve pre-service education on malaria diagnostics and treatment. The project makes sure that training curricula for laboratory and clinical staff are aligned with current WHO guidelines and national policies.
Improving the quality of rapid diagnostic testing. RDTs are used to diagnose malaria at many sub-district level health facilities, health posts, and rural health centers that do not have access to functional microscopes. To improve the quality of testing in these facilities, the project is coordinating with partners to build the diagnostic skills of CHWs and community health assistants and to implement quality assurance activities.
Conducting outreach training and supportive supervision. MalariaCare provides onsite training and ongoing supportive supervision for clinicians and laboratory staff to strengthen case management services in health facilities. During visits, supervisors from the provincial and district levels provide support to clinicians and laboratory staff, using a checklist to identify areas that require improvement. The project organizes an annual workshop for supervisors to share lessons learned from the visits and plan next steps.
Creating tools for treatment of malaria and other illnesses. MalariaCare is developing job aids with clinical algorithms to be explained and distributed during supervision visits. The posters will assist clinicians in determining optimal treatment for malaria patients as well as appropriate testing and treatment of febrile illness for patients with a negative malaria test.
Highlights from 2013
- Supported on-the-job training and supervision of laboratory staff and clinicians during 216 supervision visits to health facilities.
- Conducted a malaria diagnostics refresher training for 18 district-level laboratory supervisors from across the country. Following the training, participants achieved a mean score of 96 percent success in microscopy competence.
- Printed and distributed 200 copies of an updated national malaria laboratory training manual to more than 20 health facilities in each province.
- Held a training workshop for NMCC data managers to improve skills in analyzing and using quality assurance data for national program decision-making.
Zambia case study 1: Supporting providers on the front lines of malaria control pdf (535K)
Zambia case study 2: Real time data improve quality of care pdf (406k)